Pharmacologic Treatment for Meniscus Tears
For meniscus tears, NSAIDs (oral or topical) are the primary pharmacologic agents recommended for pain management, combined with structured physical therapy as first-line treatment, while avoiding arthroscopic surgery for degenerative tears. 1, 2
First-Line Pharmacologic Management
Oral or topical NSAIDs are recommended as the primary analgesic agents for managing pain associated with meniscal tears, particularly in degenerative tears in patients over 35 years old. 2, 3, 4
NSAIDs should be used as part of a comprehensive conservative management strategy that includes structured physical therapy with quadriceps and hamstring strengthening exercises. 1, 2
Weight loss is essential for overweight patients, as it significantly reduces knee pain and improves function—this is a critical non-pharmacologic intervention that enhances the effectiveness of analgesic therapy. 2, 3
Second-Line Pharmacologic Options
Intra-articular corticosteroid injections may be considered if there is inadequate response after 3 months of conservative management with NSAIDs and physical therapy. 2, 5
Viscosupplementation (hyaluronic acid injections) can be considered in the presence of concomitant osteoarthritis, though this is typically reserved for patients who have failed initial conservative measures. 3, 4
Platelet-rich plasma (PRP) and other orthobiologics are becoming increasingly popular but still require higher-level investigation before they can be routinely recommended. 3, 4
Critical Treatment Algorithm Based on Tear Type
For Degenerative Meniscal Tears (Age >35, Insidious Onset)
Do NOT proceed to arthroscopic surgery, even if mechanical symptoms like clicking, catching, or intermittent "locking" are present—these symptoms respond equally well to conservative treatment with NSAIDs and physical therapy. 1, 2, 5
High-quality evidence from multiple randomized controlled trials demonstrates that arthroscopic partial meniscectomy provides no clinically meaningful improvement in long-term pain or function compared to conservative treatment with NSAIDs and exercise therapy. 6, 1, 2
Less than 15% of patients experience small, temporary improvements at 3 months after surgery, and these benefits completely disappear by 1 year. 2, 5
For Traumatic Meniscal Tears (Acute Injury, Younger Patients)
Pharmacologic management with NSAIDs remains appropriate for initial pain control, but surgical intervention (meniscal repair when feasible) may be indicated for bucket-handle tears causing true mechanical locking (objective inability to fully extend the knee). 1, 2, 7
Meniscal repair is superior to partial meniscectomy with better functional outcomes and less severe degenerative changes over time when appropriately selected. 6, 7, 8
Common Pitfalls to Avoid
Do not rush to surgery based on MRI findings alone—degenerative meniscal tears are common incidental findings in middle-aged and older patients that do not correlate with symptoms, and pharmacologic management with NSAIDs plus physical therapy should be the first-line approach. 2, 5, 3
Do not interpret clicking, catching, or intermittent "locking" as indications for surgery—these mechanical symptoms do not predict surgical benefit and respond equally well to conservative treatment with NSAIDs and exercise therapy. 1, 2, 5
Do not assume all meniscal tears require pharmacologic intervention—the majority of degenerative tears are asymptomatic, and treatment should be reserved for symptomatic patients. 3
Treatment Duration and Expectations
Conservative management with NSAIDs and physical therapy should be continued for at least 3-6 months before considering any escalation of treatment. 2, 5
Pain tends to improve over time with conservative management, as symptoms naturally fluctuate in this chronic condition. 2
If severe degenerative disease persists after failed conservative management with NSAIDs and physical therapy, total knee replacement (not arthroscopy) is the definitive therapeutic option. 2, 5